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Conditions: BPH

Diagnosing BPH

Your doctor will probably start by taking a thorough medical history, which will include asking how much fluid you normally drink in a day and what medications you’re currently taking. (Some drugs—such as certain bronchodilators, decongestants, and appetite suppressants—may bring on urinary symptoms.) You’ll need to tell your doctor if you have a family history of coronary artery disease, hypertension, or diabetes—conditions that complicate management of BPH.

Your physical exam will likely include a digital rectal exam, in which the doctor inserts a gloved, lubricated finger into your rectum to feel for any abnormalities. Your urine will be checked for blood, sugar, signs of infection, and depending on your symptoms, for cancer cells (to rule out bladder cancer). Your doctor may take a blood sample to check your level of prostate-specific antigen, a measurement that rises with prostate disorders. In addition, the speed of your urine flow after you’ve held your urine for some time and the volume of urine left in the bladder after you have voided may be measured. These measurements can help the doctor determine the extent of your urinary tract obstruction.
 
In assessing your symptoms, your doctor will likely use one of two well known aids: the “BPH Symptom Score Index” (see the box on page 5), which was developed by the American Urological Association (AUA) or the International Prostate Symptom Score (IPSS) developed by the World Health Organization. The IPSS is identical to the BPH Symptom Score Index except that, in addition to the seven multiple-choice questions about urinary symptoms, it contains an eighth about how bothersome you find the symptoms. Your answers to the questions can help your doctor determine the nature, frequency, and severity of your LUTS and how they may pertain to BPH.
 
If your symptoms are not severe and you have no signs of serious injury to your urinary tract, your doctor may suggest a period of regular symptom monitoring with no immediate treatment. If, however, you have symptoms that are moderate to severe, a significant family history of BPH-related problems, or serious urinary tract injury, then medical, minimally invasive, and surgical treatments are available (see box on page 4).

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